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Hobbyists, Artisans and Manufacturers - what do they tell us about automation?
As I get older, I find myself getting less and less sleep, and watching more and more late-night television. One program that seems to have captured my interest is called "How it's Made" that details manufacturing processes for common (and some uncommon) household items.

While watching this program the other night, I was struck by the notion that industrial automation looks a lot different than what we have generally sought, especially in pharmacy compounding automation, where we seem to be really attracted by the notion of a single device that accepts an electronic 'order', produces the corresponding dose (or doses) complete and labeled, and leaves us blissfully uninvolved in between.

This got me thinking about where you find these 'all-things-to-all-people' devices in the more general marketplace (looking outside pharmacy practice), and where you don't, and I found myself thinking about the range of people who do woodworking. I suspect that my analogies will not hold up to really close scrutiny, but bear with me on this.

My brother is a woodworking hobbyist. He's pretty good at it, but he doesn't do a lot of it. He owns a device called a Shop Smith that is kind of a transformer for wood workers; a machine that can do it all. It's a lathe, a band saw, a table saw, and a drill-press all in one. It's not exactly like a 'makes-any-dose-you-can-imagine' machine, but it has conceptual relationship. He has, over the years, done a lot of work on that device, but its general utility works primarily because he never does a lot on it at one time, and because his own expectations of his work aren't stratospheric.

Over the years I have also known individuals I would call wood working artisans. Think Norm Abrams on the New Yankee Workshop on PBS. If you look at their shops, they have lots of automation, but each piece does only one thing, and does it very well. If they need to turn wood, they have a really good lathe. If they need to cut large pieces of wood, they have table saws. If they need to cut complex wood joints, they have joiners and power miter boxes. What you don't find is a one-size-fits-all device that tries to do it all. Indeed, as my brother's talents in this area have grown, he has wound up purchasing more specialized tools for the jobs he does most often! Like the hobbyist, the artisan still turns out individual pieces of work. The difference is that the artisan's expectations of their own performance is higher, and therefore they demand more of their tools.

When I have visited factories, or watched (for example) how furniture, or clothing, or baseball mitts are manufactured on TV, I have noticed that this idea of specialized devices for special jobs takes on an even greater role. In the processes I have observed, the automation has become even more specialized, more directed. Instead of being a set of generalized tools, the assembly of tools becomes a collection of very highly specialized tools that do one part of an assembly process very well, and very reliably, and then hand off the product of their work to yet another tool that performs the next step. Each of these tools is completely customized to what is being made; and often the individual tools are themselves from individual manufacturers. 

In manufacturing, the arrangement of these tools, and their intermediate products is often parallel. That is, the work is performed in a way that guarantees that any tool has a ready supply of intermediate parts to be certain that it is not idle waiting for something else.

Note that this is in large measure practical because in manufacturing, unlike artistry or hobby, the goal is to produce a lot of identical, or nearly identical items of very high quality in a hurry.

So what is your pharmacy? Is it a hobbyists shop? Is it an artisan's studio? Is it a factory? I dare say that few of us would consider ourselves hobbyists at what we do. I think that few of us would consider ourselves factories. The closest analogy seems to be that of an artisan. While we make similar kinds of things on a day-to-day basis, each compounded dose is individually crafted for a specific patient. That crafting relies on our skill, knowledge, and experience to prepare it properly. Those attributes are magnified by our selection of tools we used to craft those doses.

So what does this imply about our automation? Is our quest for a single device that does it all misplaced? Would our automation story be more successful if it was a collection of tools that each did one thing well? What if IV automation, for example, took a set of orders, used it to queue up a tool that produced vials of additives (some of which had to be reconstituted), queued up syringes on a device that knew how to make syringes, queued up bags on a device that knew how to make bags, queued up specialty devices (CADD pumps, PCA's etc) on devices that knew how to make them, and then initiated preparation on each of the devices as soon as the source containers were available for them to use? What if, like a factory, these tools were connected by technology that moved intermediate products from one tool to another?

Like I say, I don't really know if this holds water. I do know that our automation endeavors today, especially those that are used to compound doses, seem to lack either the speed, or the flexibility (or both!) to do the job we really want them to do. Maybe it's because we are expecting too much of a single device.

What do you think?
Created By: Dennis Tribble On: Fri, Apr 06, 2012 02:29 PM

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Dennis Tribble April 10, 2012 1:03 pm
I am personally aware of one instance where a hospital used information from a dose management system to inform an industrial engineer and create a wholly new work flow. I am aware of one vendor using human factors engineers to redesign their product. I have seen marketing information from several automated carousel vendors describing modifications in work flow around product acquisition that purports to be the result of the application of industrial design to pharmacy product selection work flow. I am not aware of hospitals using industrial engineering to design and deploy new automation tools.
I am aware of one researcher at the University of Cincinnati using cameras to record and study work flow within pharmacies and to propose alternative, more efficient work flows.
I have raised the question as to why we seem to be waiting for the vendor community to peform analysis of our practice environment as opposed to studying it and understanding it ourselves.
Matt Maughan April 10, 2012 9:53 am
I really enjoyed the article and I would also agree that the concept is correct. The current IV rooms at most small, mid, and large IV rooms feel like artisanal shops. It makes me wonder how many industrial engineers have looked at our work space and made a close study of pharmacy workflow and production. In your experience, has that been a focus from the vendor community?
Jerry Fahrni April 08, 2012 10:25 pm
Hi Dennis - Thanks for the thoughtful commentary. Automation and technology in the IV room has been on my mind for quite some time and I tend to agree with your line of reasoning here. I think we're in a sort of limbo at the moment. Most of the technology we're churning out in the IV room feels more like a bridge to the future than anything else. We just haven't quite figured it out yet. All we have to do is stop trying to mimic humans. Once we do that it should be a piece of cake (grin). - Jerry

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